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17084 POST THIS CARD NEAR FRONT OF BUILDING P ERMIT NUAp ER CITY OF CUPERTINO r , INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION ��..�..� JOB ADDRESS �'l..l •W� QQC/ UNIT# A_ LOT# � CI PERMIT EXPIRES IF WORK OWNER QPE�vOC-r/G. O �� CONTRALTO IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: - LAST CALLED INSPECTION. LIFER � ALL GRADING AND DRAINAGESHALLBE INSTALLED PREGUNITE ' - TO COMPLY WITH THE APPROVED PLANS AND CITY OF IM VALIDATION CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING + . ;1 - JNOTPOUR AL ISSUANCE DATE AL Aig BLDG ELECT. LG. �MECH ❑ ❑ ❑ OUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I'�1 u V lyjj BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT. AL `fy7 Z2)AL - � "U"',', INON STORIES TYPE CONSTR. I -OCC GROUP " RES UNITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE HFS IND CON PB ow, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGHSAN.q ASSESSORS PA HCEL NO , PLUMBING ELECT.ENERGY + TUBS B SHOWER PAN PLUMBING ENERGY - TRACT NO. PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE No FRAMING ELECT.FINAL TEST - 1 INSULATION PLUMBING ZONING ENG,SITE NEI GAS'TEST - - GAS - MECHANCAL FIRE SPRINK `ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ❑ NQ EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE A.L u.c. INTERIOR SHEAR FIRE DEPT.. Y❑ N ° ❑ N❑I SHEETROCK GRADE FEE SUMMARY C EXTERIOR LATH INTERIOR LATH BUILDINGTEMPORARY APPROVALS euILDwG SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY UFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC . 0ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING' Z -PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE � CALLING FOR FINAL INSPECTION. . TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY i B I LDI NG PROJECT I DENTI FICA710N .PERMIT NUMBER nUILOING /D� QL�E APPLICATION & PERMIT f�O AOOREss 1 ION 2 BUILDING-ELECTRICAL-'PLUMBING-MECHAN84 ICAL T OW EP'S NAME �� QTY PLAN CHECK VALIDATION ` ELECTRIC PERMIT FEE PHONE ; ,..J NNMTR"cTORs 'C A OUTLETS-SWITCHES-REC 10.00/100 •SO LIC.--4_664V LIGHTING FIXTURES CONTRACTOWS qGg . APPLIANCES-RESIDEN AL- 4.00 O AD Z 2 _ L FI/ /S( a PNONE PANELS $ IO.00 a/�'ITE OF APPLICATION ORCHrtECT PANELS (OVER 200 AMPI - 20.00 PLAN CHECK FEE P.0.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 APPLICA VALIDATION ZIP EMP.METER OR POLE INS. 20.00 �-,♦�j APPLICANTS f/0"��` AOOREss � MOTORS SEE FEE SCH. �K SERVICE CHANGE 20.00 D r02 o 2 O LICF.NSEU CONTRACTORS DECLARATION I ' M,U U I hereby affirm (hat I am licensed under provisions Of Chapter 9 ISSUANC AT a N. (commencing with Section 7000)of Division 3 of the Business and q 1 H h Z Professions Code n y license is in full for .(ZeO /I" '� .) 1l ggy BLDG. ELECT PLG. MECH, o i H o License�'as�� .Lic.Kumber �_ ❑ ❑ ❑ L H La Dute Contractor yy,,� p ¢_ ¢ w 4 OWNER-BUILDER DECLARATION ttl Q Cowin BUILDING PERMIT i'xu ;L I- I hereby aflinn that I am exempt from the Contractor's License MISC,- REFER TO ORD - INFORMATION � u-0< Law to,the following minion.(SIC,7031.5,Bushmollind Profceeions PERMIT ISSUANCE VALUATION $/FT. Hca Code:Any city or county which requires a permit to construct,alter, 10.00 Q Q 4 D Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. i w a oLLi requires tile applicant for such permit In file a signed statement that 1�TA'L1 a he is licensed pursuant to the provisions of the Contractor's License • PERMIT TO F z a Law(Chapter 9(commencing with Section 7000)of Division 3 u rthe 7�ITTO / E x r Business and Professions Code)Or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE C' - -`4`--� li ¢ HO the basis for the alleged c xemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR. aim by any applicant for apermit subjecis[lie applicant macivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred subjects 1lie ap 1: ❑ I,as owner of the properly,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.06 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within One year Of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). RES IND CON PB Coal, CI as owner of the properly,ani exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 liceEl ❑ El ❑ nsed Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 6.00 ASSESSORS PARCEL NO. and Professions Code:'fie Contractors License Law does not apply V.B.. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for Much projects with a Contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I um exempt under S,,,_,B p.C.for This r"son WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ALC:FILE NO. WORKERS'C'OMPENSATION DECLARA1'ION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Coni ensation Insurance,or a etrlil'ie ZONING copy Bier C 1 ENG.SITE NO. �e�((jj��yyqq��,.�Jf pPQ Policy No/tAl WWI ^' be IT Certified cgpy is here furnished. ((/ylfl;�/qf FIRESPRINK ENERGY T 24 Z Zcrt iIi the city inspection division. O Applican MISC.- REFER TO ORD. Y ❑ NO Y ❑ NE] � W (.:RTIF ICATI OF AENIPl'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.II.C. LU � CONP- SAl'IONINSURANCE. PLG:CONTR: LIC.NO. PLG. d O (This section need not be completed if the permit is for one TOTAL Y,� N� Y[] No ::I Z hundred dollars(SIOOlor less.) U O I certify that in the performance of the work for which this per, OTV MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. °' D°(` Apphc°m - ALTER OR ADD TO MECH. 5.00 BUILDING >_ 0 NOTICE TO APPLICANT: If,after ntd,in,this Certificate of Ex- F Z_ emption,you should become subject t0 the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with CO such provisions or this permit Shull be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE , CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE ' I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 4 I certify that I have read this application and s14m that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with ell Cil,and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or IO0,000B.T.U.I 6.00 hereby authorize representatives of this city to en ler upon [Ile BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL. /- above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 taming of this permit. MECH.CONT. LIC.NO, MECH. TOTAL TOTAL Signature of Apphcan(/Contractor Date OFFICE COPY